RT Journal Article
T1 Comparison of Different Procedural Approaches for Left Atrial Appendage Closure: Searching for Simplicity
A1 Ruiz-Salmeron, Rafael Jose
A1 Robles-Perez, Carlos
A1 Ronquillo-Japon, Maria
A1 Garcia-Borbolla, Rafael
A1 Iglesias-Blanco, Manuel
A1 Mendez-Santos, Irene
A1 Rubio-Iglesias, Carlos
A1 Ginsburg, Julia
A1 Rodriguez-Leiras, Sergio
A1 Carrascosa-Rosillo, Cesar
A1 Vizcaino-Arellano, Manuel
A1 Polo-Padillo, Juan
K1 Occlusion
K1 Outcomes
AB Aim. To assess procedural and long-term efficacy and safety of two alternative methods for appendage closure, conscious sedation with standard transoesophageal echo and procedure guided by rotational angiography. Background. Demand for appendage closure is increasing, and a reasonable time-response should be given to nonvalvular atrial fibrillation patients not suitable to receive anticoagulation. General anesthesia and the need for an anesthesiologist are limiting factors to improve procedure availability; it is time to introduce simpler approaches. Methods. Single center experience in appendage closure during 9 years, using three different procedural approaches: general anesthesia with echo guidance, conscious sedation with echo guidance, and rotational angiography guidance. Conscious sedation and rotational angiography-guided procedures were performed in the absence of an anesthesiologist. Procedural characteristics and follow-up events were recorded. Results. 260 consecutive appendage closure procedures were reviewed: 155 were performed under general anesthesia (59.6%), 71 were performed with conscious sedation (27.3%), and 34 were rotational angiography guided (13.1%). Device success rate for procedures guided by rotational angiography was significantly lower than that for general anesthesia and conscious sedation (91.2% versus 100% versus 98.6%, p=0.001) because there was a greater need to recapture and change device size. However, final procedural success was high and without difference between approaches (98.8% versus 97.2% versus 100%, for general anesthesia, conscious sedation, and rotational angiography, respectively); with a median follow-up of 17 months (CI 95% 13-23 month) (637.9 patients-year), there was no difference among approaches for thromboembolic (1.3 versus 1.8 versus 1.8) and major bleeding events (3.2 versus 2.8 versus 1.8), respectively. Conclusions. Appendage closure performed, either with conscious sedation with echo guidance or rotational angiography guided, is feasible, with no difference in procedural success and follow-up events compared with general anesthesia and without the limitation of the need for an anesthesiologist on-site.
PB Wiley-hindawi
SN 0896-4327
YR 2021
FD 2021-01-25
LK http://hdl.handle.net/10668/19079
UL http://hdl.handle.net/10668/19079
LA en
DS RISalud
RD Apr 12, 2025